Alternative Birth Methods

There are many methods for childbirth that do not involve medications.  There are also many reasons why someone would choose not to have medication.  I used to be completely against medication-free births because my thought was why the heck would you want that if you have modern medicine? Well, silly me, there are many reasons.  Some reasons other moms have told me are:

• because medication makes them feel funny/out-of-control 
• they have an immense fear of needles
• having control over their body is more comforting than being numb
• to be able to labor and deliver in the position of their choice
• they believe all drugs are harmful (not true, but this isn't coming from me)
• they want to feel more connected to their baby (I also disagree with this one)
• just to feel like a warrior princess (ay ya ya ya ya!! xena!! please tell me I'm not the only one who grew up watching xena...)

For me, it was having more control over my body. Aside from the whole blood pressure fiasco with an epidural, I loved being numb and feeling relaxed while laboring. I could chill, watch a movie, chat- it was great. But tell you what, when I felt the grinding of the forceps deep within me, even my fatigued i've-been-pushing-for-three-plus-hours thoughts couldn't hide oh lawdy, this is gonna be a scary recovery. And it was. So when I was preggers with number two, I researched and researched a method that could get me through contractions and have some kind of peace during labor. And with preparation, I was able to achieve my goal!

Before going too into my own experiences, I want to highlight the most common alternative birthing methods:

Bradley Method

The whole course is focused on learning to "trust your body" because birth is a natural process.  It teaches key relaxation techniques and overall good health habits during and after pregnancy.  Pain management is focused on the body relaxing and embracing any pain as part of the natural process. The class is 12 weeks long and is taught by an instructor, so you would need to be able to attend an actual course.  I'm sure there's a modified version where you can learn from home, but the Bradley Method is a registered trademark and is based on this 12 week course, starting around 5 months pregnant.  The class heavily relies on having your husband or significant other as a coach, so those who are more independent may not like this option.  Link to official course here.

Lamaze

The Lamaze method has been around since the 1950's and from what I'm reading now at this present time, there has been a shift in method to a more general focus of "increasing women's confidence in their ability to give birth."  The method was known for its classic "hee-hee-hoooooo" breathing technique.  Now, they focus on the whole aspect birth- before and after. The method wants you to feel prepared for anything and to have as few interventions, like artificially rupturing membranes or epidurals for example, so that you can let your body do what's most natural. They are supportive of birthing positions other than being on your back.  Pain management is much like the Bradley Method in that it is a natural process of childbirth and learning relaxation techniques can help minimize the pain and help you cope.  The course is usually around 12 hours- the duration really depends on the instructor, so anywhere from 4-8 weeks.  They also have online course opportunities.  See more on the official site here.

Hypnosis

The main focus of using hypnosis for childbirth is having a peaceful, gentle, and painless childbirth.  I know, it sounds kooky as soon as I said painless, but for many women, it is painless.  In general, self-hypnosis techniques are taught in these kinds of classes/books and by utilizing these techniques, a peaceful and fearless childbirth can be achieved. The main emphasis is total relaxation and using hypnosis to change your perception of pain.  One of the main ways to achieve this is reducing the negativity around your regarding birth. Every woman who has given birth has some kind of significant experience and sometimes it is less than ideal, so naturally they want to share and warn other expecting moms of their issues.  Well, if you are particularly sensitive, this kind of information can instill a little fear regarding childbirth and make it challenging to have total relaxation. Using hypnosis can be as structured as you'd like or be more flexible and self-taught with the guidance of a book.  From what I've gathered, there are two main classes to utilizing hypnosis for childbirth:

• Hypnobabies (what I used)
• The Mongan Method

Hypnobabies is both an instructor-led course or home-study course. The class is set up to be completed at a minimum of 6 weeks or longer.  There are 6 sections and many women take 2 weeks per section, totaling 12 weeks. The home-study course is a set of CDs with hypnosis scripts on them , narrated by the Hypnobabies founder, Kerry Tuschhoff.  There is also a workbook that structures the class and has additional reading to study on your own.  Attending a live class just goes over the workbook and scripts on the CD and is more ideal for people who are less self-motivated for a home-study course. Link to official course here.

The Mongan Method, by Marie Mongan, is similar to Hypnobabies except that it focuses more on an instructor led class.  Otherwise, much of the techniques are similar in teaching self-hypnosis.  There are not CDs or set hypnosis scripts, so it relies more on the student to master these techniques on their own. Marie Mongan has written a book that can be used as a basis for a home-study course, but it is not as structured as her course.  The actual course is 5 classes long, about 2-3 hours each, so the duration of the overall course is set by the certified instructor.   Link to official course here.

Other- there are many ways to learn self-hypnosis.  Google is filled with endless possibilities. Self-hypnosis is nothing new as people with allergies or anxiety have been using the techniques for at least the last 15-20 years with dental and minor surgical procedures. I would be weary of buying a course other than the two listed unless you have read testimonies of other moms' experiences who you know and trust.

Water Birth

A water birth is not necessarily a method, more of a position in birth, really.  You can use any method and have a water birth.  The whole point of a water birth is that it is supposedly an easier transition for baby to go from womb to warm bathtub water instead of cold air- makes sense to me! Moms also may prefer having a water birth because they feel lighter and less pressure on their whole body if they can float a little, lessening childbirth pains.  Water births can be anywhere- many hospitals that are supportive of alternative birth methods are beginning to include birthing tubs as an option to labor in and even give birth in! Some women who choose to have a homebirth will get a blow-up pool and set it up in their living room. Water births are illegal in some states, so check before planning your dream birth. http://www.waterbirth.org/ has a lot of helpful information regarding water births.

DIY

I say do-it-yourself because there are women who choose not to follow any of these methods and do so successfully.  If you think you have enough willpower and self-motivation to go without a course of any kind, then just make sure you research interventions before D-Day so that you can give your truly educated informed consent before receiving any interventions.  A few books that either I have read or have heard good things about are:

• Ina May's Guide to Childbirth- Ina May Gaskin is a nurse midwife who's like the ultimate natural birth guru. She is totally hippy and has a lot of good insights.
• The Birth Partner- by Penny Simkin. It is a guide for your supportive partner/doula during childbirth
• Hypnobirthing- by Marie Mongan.  I mentioned her earlier- her book is a great intro to hypnosis for childbirth and also shares key techniques for relaxation.
• Natural Hospital Birth- by Cynthia Gabriel. This is an empowering book but I would just keep in mind that although it suggest to always stand your ground, it is a good idea to ask educated questions regarding an intervention that is suggested (ex. so why do I need to have an IV? or what happens if I don't have my membranes ruptured right now?)

Now that you are aware of some options for alternative birthing methods, here are your three main options for places to birth at (and while I want to say these are your only options, you can always find a YouTube clip for something like a "natural birth in the woods" or "childbirth in nature with community group." It's true.) -

Home Birth

Some women dread the idea of being in a hospital full of sterile items and medical professionals or perhaps home is the place they are most comfortable at for everything, childbirth included.  Whatever the reason, this is a popular choice among many moms choosing alternative birth methods.  Generally, you have a midwife who will come to your home and you labor where you are most comfortable at. Some women deliver on their bed, others in the living room.  As mentioned earlier, a water birth can be set up in your home too. I'm sure this will rub some people the wrong way, but I am not an advocate of home births.  Emergencies are uncommon, but if they occur, I certainly would not want to be at home.  Also, I am lazy and I would not want to clean up... birthing goo.

Birth Center

A birth center is now a more common option.  Many are set up near a hospital and are like a bed and breakfast set up practically, but with necessary medical equipment.  You have the comforts of a homey-feel yet you don't need to worry about anything in your actual home.  I have heard of many positive experiences regarding stand-alone birth centers. Some hospitals are beginning to have birth centers within them- kind of like a hospital within a hospital.  I love this concept.  I had my daughter at a birth center within a main hospital and the staff were supportive of my decisions and I got to labor/deliver and recover in the same room, which was wonderful.

Hospital

There seems to be a shift in hospitals now with their L&D units- I see a lot more mom support now with alternative medicine and less intervention pushes.  There is also a lot of breastfeeding advocacy and the concept of skin-to-skin contact (learn more about Kangaroo Care here). A hospital is a safe place to be at to deliver.  What it all really comes down to is if your provider you choose is supportive of your childbirth wishes and plans because if they aren't, the hospital staff are less likely to be.  I always look for a provider who is on the same page as me because after my first experience, I realized that besides preparation, I depend a lot on my provider too to support me.

I hope this information can help you make an informed decision about what route you may want to take regarding your birth experience!

As I mentioned earlier, I did use Hypnobabies.  If you want to read about my birth experience, you can check it out on my family blog. 

Pain Relief During Labor

Pain relief.  I know that was the first thing on my mind when I truly felt and knew what a contraction was the first time I was in labor.  I'll just begin by saying that you will NEVER understand what a contraction is like until you feel it for yourself.  No blog, book, person's word will teach you better than your own body. Oh boy.  The first time I felt a true contraction, I was stoked. This is it! Contractions are just like my period cramps! Not bad! How naive... I had just graduated from nursing school and passed my boards and learned a lot of science in regards to labor, but not a lot in the actual experience.  I really wasn't sure what labor was going to be like, so I did not prepare much in regards to pain relief.  I basically decided that I would see what it felt like first and then get an epidural if I really needed some relief.  Tell you what, I was begging for an epidural as soon as the triage nurses decided that I was actually in labor and those two or three hours I didn't have any relief were agony.

Knowing what I know now, I wish I researched all my options very carefully.  Pain relief is definitely possible in multiple ways, most commonly through medication. Let's go over our options, ladies:

Epidural

I am putting this one first because it is the most common one we all hear of.  Talking about epidurals will probably be the longest response out of all the pain relief options.  Epidurals are a regional anesthetic, which basically numbs you from waist to knees, if not toes too.  You will begin with a 1-2 liter fluid bolus as an epidural will generally lower your blood pressure.  A anesthesiologist or nurse anesthetist will place the epidural.  It is placed in the lumbar region of your spine- about where the curve of your back is.  They will have you either sitting on your bedside, hunching over a bit, or laying sideways in a "fetal" position:

The provider will first numb the skin/tissue in front of your spine with a local anesthetic (Lidocaine) and then proceed to first insert a hollow needle (Tuohy needle) between your vertebrae into the epidural space, the space between your spine and spinal cord that's filled with cerebrospinal fluid (CSF).  Next, they insert a thin tube (catheter) into the Tuohy needle and thread it up a couple of centimeters, remove the Tuohy needle, hook it up to a pump, and begin a continuous infusion of anesthetic (usually some kind of -caine ending medication [lidocaine, bupivacaine, etc.] and a mix of something else like a narcotic).  The catheter is taped down your back and you should be feeling fairly numb by now.

A lot of times they will give you a patient-controlled button to press when you feel like the medication is wearing off and needs a boost.  This is called a patient-controlled analgesia (PCA) pump. Some women find the epidural placement uncomfortable and others may not even notice it since they are too focused on their contraction pain (me).

Pros- complete pain relief, obviously.  There's a reason this is one of the most common pain relief options for labor! Also, the medication does not cross the placenta/blood barrier, so it wouldn't directly affect the baby.  All those reports of epidurals causing groggy babies are lies.  Haterz gonna hate!  Epidurals can sometimes be what your body needs to just relax enough to dilate/efface completely and push the baby out too.

Cons- there's a nasty adverse reaction of dropping your blood pressure too low.  It doesn't happen to everyone, but it can happen and can vary.  For me, it was quite unpleasant as my blood pressure suddenly dropped from its usual 115/80 to 70/50 or less immediately.  This caused me to feel faint and dream like and both my son and I were not getting enough oxygen.  Fortunately again for modern medicine, there are medications the anesthesiologist will be equipped with to reverse these kinds of reactions and the nurses are trained to respond quickly.

So indirectly, yes, an epidural could affect the baby, but most women seem to have a positive experience.  There's also always the possibility that the epidural won't work, won't last, or only affect one side.  From being completely numb, you may or may not have as much ability to push the baby out so you rely a lot more on the nurses and provider telling you when to push.

Visual aid of an epidural placement:

Spinal Block

So similar to an epidural placement, a spinal block will be administered much the same except it is a one-time injection of anesthetic into the CSF instead of a steady flow.  Spinal blocks last only 1-2 hours because of this.  As I mentioned in a previous post, this is more commonly given when having a c-section, but sometimes you may have this as an option. With both a spinal block and epidural, you will definitely get IV fluids, a urine catheter probably, and your blood pressure will be monitored.

Pros- much the same as an epidural. Complete pain relief! Shorter duration (which could be a con I guess if you still need the pain relief) and does not directly affect baby.

Cons- From what I've read, the severe headaches associated with a spinal block (spinal headache) are much less common now, but I guess that's always a risk.  They occur from a little of your CSF leaking from the puncture site and the headache lasts for 24 hours at most typically.  Low blood pressure is also a side effect too.

Narcotics

Narcotics, or also called opioids, can be given intravenously (IV, through a vein) or intramuscularly (IM, into a muscle like your shoulder, leg, or buttocks) and will not numb you completely.  They basically "take the edge off" of the pain.  Some common medications a labor nurse told me they use are fentanyl, stadol, or nubain.

Pros- it lasts a couple of hours and may just decrease enough pain for you to still move around during labor, if that's what you want to be able to do.

Cons- I am not a huge advocate for narcotics just because these do cross the placenta/blood barrier and could directly affect baby.  It's safe enough- narcotics are rated by the FDA as category C, which basically means that there is insufficient data to say it definitely or does not affect your unborn baby and that if needed, your provider can choose to give it to you.  Some babies will be born a little groggy and if too sleepy, they will be given an IV narcotic reversal medication called naloxone, or also called Narcan. Narcotics can also make you a little too sleepy, so take that into consideration.

Other medication

I'm categorizing everything else as other mainly because I highly doubt that you will use anything else besides what's listed.  These are less common, but still options depending on where you deliver:

Nitrous Oxide- I've only seen people outside of the US using this during labor.  It is an inhaled analgesic and makes you relax, a lot like a narcotic, but shouldn't affect baby directly.

Local Anesthetic Injection- I am unaware of this being an option before the baby is born, but I suppose it could be.  A shot of anesthetic, like Lidocaine, will be directly injected into your vaginal walls or perineum, causing numbness.  Usually, it is given when suturing tears or an episiotomy. There is not effect on baby.

Alternative Pain Relief

I will go into unmedicated births in an upcoming post, but I just wanted to list a few different methods people use for pain relief without medication:

• hypnosis (this is number one and very biased as this is what I used)
• breathing techniques
• redirection (focus! you'll be holding a little baby soon!)
• pressure points- certain acupuncture points can assist with pain relief
• movement
• yelling at loved ones and strangers- hey, it could help.

Most of the alternative pain relief options are focused on trying to totally relax your body and reduce the anxiety associated with labor and feelings of pain.  After all, pain is subjective meaning it varies from one person to another- what is excruciating pain to one mom may just be tolerable for another, but whatever it is, it is still very real for that person so that's why we need to treat it with what works for you.

*Thanks to MayoClinic.com for all the helpful pictures and information and Drugs.com for medication references.